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PubMed2003

Scar quality and physiologic barrier function restoration after moist and moist-exposed dressings of partial-thickness wounds.

BACKGROUND: There is growing evidence of improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments. Retention of biologic fluids over the wound prevents desiccation of denuded dermis or deeper tissues and allows faster and unimpeded migration of keratinocytes over the wound surface. It allows also the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and re-epithelialization. Despite all of these documented benefits, applying the moist healing principles to large surface areas, in particular to large burns, is hindered by the major technical handicap of creating and maintaining a sealed moist environment over these areas. METHODS: From January to September 2001, healing of partial-thickness skin graft donor sites was studied in a prospective comparative study of two types of moist dressings, Tegaderm (3M Health Care, St. Paul, MN), a semipermeable membrane occlusive dressing, and moist exposed burn ointment (MEBO) (Julphar; Gulf Pharmaceutical Industries, United Arab of Emirates), an ointment that can provide a moist environment without the need of an overlying occlusive dressing. Healing was assessed both clinically and with serial measurements of transepidermal water loss (TEWL) and moisture. Following healing, scar quality was evaluated by two members of the team separately using a visual analog scale. Results were statistically analyzed. RESULTS: Faster healing was observed clinically with MEBO application. Physiologic healing as determined by TEWL measurements occurred at an extremely significant earlier stage for MEBO, and this was associated with better scar quality, demonstrating a positive relationship between function and cosmetic appearance. Moreover, the ointment is definitely easier to apply than the occlusive self-adhesive membrane, which requires some degree of dexterity and expertise. CONCLUSION: MEBO application is an effective and valid alternative to conventional occlusive dressings. Moreover, the observed improved anatomic and physiologic healing indicates that MEBO may have a positive effect on healing more that the mere fact of passive moisture retention.

Adult↗
PubMed2004

[Vacuum assisted wound closure after excision of a high risk melanoma heel wound - using the v.a.C. heel-dressing].

Vacuum-assisted wound closure is established in acute wound treatment and assists granulation tissue as well as promotion of graft survival in critical localisation. A new vacuum-assisted wound closure device is launched for the treatment of heel wounds (V.A.C. GranuFoam Heel Dressing). First experience with this heel contour shaped dressing is presented in a case of primary surgical care of a high risk melanoma. The initial defect after excision, measuring 8 x 6 x 3.5 cm, granulated by V.A.C. treatment in 5 weeks to skin surface niveau and was successfully covered with a full thickness skin graft. The V.A.C. Heel Dressing is easy to apply, reduces vacuum leakage und increases patients' comfort and treatment safety in comparison to "classic" vacuum dressings.

Debridement↗
PubMed1998

The influence of occlusive dressing and hyperbaric oxygen on flap survival and the healing of ischaemic wounds.

The effect of dressing with Duoderm (hydrocolloid) and treatment with hyperbaric oxygen was investigated on the healing of ischaemic incisional wounds and on flap survival in rats. After 10 days, Duoderm dressing of ischaemic wounds decreased all strength parameters (load*S, stress*S) by 41%-44% and the improvement of ischaemic wound healing by hyperbaric oxygen treatment shown in our previous study was not seen. After removal of Duoderm on day 10 the biomechanical properties had improved but not returned to normal on day 20. In the dressed animals the shrinkage of ischaemic wounds and the extension of necrosis on the ischaemic flaps were reduced. Dressing may be useful clinically in preventing superficial dermal necroses. One must, however, be aware of the impairment of the wound strength of the incisional wounds.

Animals↗
PubMed1980

Evaluation of biological dressings.

The use of biological dressings in the treatment of burns is reviewed. Many theoretical advantages were initially proposed, but time and controlled studies have disproved some of them. Biological dressings are nevertheless helpful in relieving pain, protecting exposed vital structures, reducing exudative protein and erythrocyte loss and evaporative water loss, protecting granulation tissue, antibacterial activity, and testing a recipient bed's readiness for grafting. They probably offer no benefit in final wound debridement and primary dressings for partial thickness burns or split skin donor sites. There is no conclusive evidence that biological dressings alter epithelialization or the rate of formation of granulation tissue. A review of our last 100 cases at the Bothin Burn Center generally supports these conclusions with evidence of the superiority of homografts over heterografts.

Bandages↗
PubMed2001

Nipple-areolar reconstruction: a different approach to skin graft fixation and dressing.

Nipple-areolar reconstruction (NAR) is now an integral component of any type of breast reconstruction. This study presents a simple and reliable skin graft fixation and dressing technique used on 278 NARs in 221 patients from 1996 to 2000. Nipples and areolas were reconstructed with a modified skate flap and a full-thickness skin graft, respectively. Skin grafts were sutured and stented using Steri-Strips. A Tielle hydropolymer dressing with a central fenestration was used to cover the whole nipple-areolar complex. The nipple is dressed further with gauze and Microfoam tape. All nipples demonstrated 100% survival. There was one partial skin graft loss and 5% of the grafts had mild epidermolysis with eventual full reepithelialization. This dressing regime is simple and reliable in ensuring optimal skin graft take and nipple viability. It provides compression of the graft to prevent shearing and fluid accumulation, excellent absorbing capacity, a moist environment to promote wound healing, and maximal patient comfort.

Breast↗
PubMedDate not supplied

The efficacy of adhesives in the application of wound dressings.

The use of adhesive preparations to reinforce surgical tapes and to secure dressings to the skin is standard practice. BioBrane is a biosynthetic membrane for use in dressing clean, well-debrided wounds, particularly partial-thickness burns and skin graft donor sites. The close and undisturbed contact of this material with the wound surface is important during the first 2 days after its application to achieve adherence. This has prompted a study to test the relative anchoring strength of four methods of securing the dressing to the normal skin around the wound: 1/2-inch (1.27-cm) Steri-Strips only; Mastisol, a mastic compound, with and without 1/2-inch Steri-Strips; and compound tincture of benzoin, USP, in combination with 1/2-inch Steri-Strips. The results obtained with a tension of 1.1 pounds/square inch (0.5 kg/6.5 cm2) were not conclusive as to the superiority of any one method. However, with a tension of 2.2 pounds/square inch (1 kg/6.5 cm2), the combination of mastic compound and 1/2-inch Steri-Strips provided the strongest adhesion. This type of application should also prove useful when other types of surgical dressings must be anchored in place.

Adhesives↗
PubMedDate not supplied

Biobrane wound dressing used in the treatment of toxic epidermal necrolysis: a case report.

Toxic epidermal necrolysis results in skin sloughing that resembles a partial-thickness thermal injury. If the exposed dermis can be protected from infection and desiccation, regeneration can occur from the skin appendages. Biobrane, a synthetic wound dressing, has been used with good results on donor sites and outpatient partial-thickness burns in our institution. We report a case of a 12-year-old boy with toxic epidermal necrolysis, whose skin lesions were dressed with Biobrane temporary wound dressing. The Biobrane dressings prevented infection, decreased wound pain, and allowed uncomplicated healing in this patient.

Biocompatible Materials↗
PubMedDate not supplied

Evaporative water losses through a temporary wound dressing under simulated wound conditions.

Patients with burns lose large amounts of water through evaporation from open wounds. Because the wound covering is the first line of defense for maintenance of body fluid balance in these patients, quantification of the evaporative water loss through wound coverings at the bedside would improve the accuracy of estimations of body water loss. The present experiment evaluates the use of a small ventilated capsule system automated with miniature resistance-type dew-point sensors for measurement of evaporative water loss through biologic dressings under simulated wound conditions. Evaporative water loss from wounds was simulated by pilocarpine-induced profuse sweating on the forearm. Evaporative water loss through uncovered skin was compared with that of skin covered with commercially available temporary wound dressings. Compared with an adjacent unstimulated area, forearm dew-point temperature in the capsule (Tcdp) and sweat rate increased immediately after pilocarpine exposure and remained significantly elevated and relatively constant for an additional 60 minutes. Evaporative water loss of the forearm was 29 +/- 4.8 gm/m2/hr (mean +/- SE) at baseline and rose significantly to 275 +/- 18.2 gm/m2/hr after pilocarpine exposure. The pilocarpine-stimulated sweat rate and Tcdp at neutral conditions were similar to those obtained from walking on a treadmill for 60 minutes in a 30 degrees C room. Compared with pilocarpine-induced evaporative water loss of the uncovered skin, temporary wound dressings significantly reduced evaporative water loss by 40% to 60%. No significant differences were observed between varieties of temporary wound dressings differing in thickness and/or porosity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Unna's boot dressings facilitate outpatient skin grafting of hands.

Present day economics have challenged health care providers to minimize the length of hospitalization without sacrificing quality of care. Within this context, the purpose of this study was to determine whether supporting the hand and wrist with an Unna's boot dressing (Medicopaste bandage; Graham-Field, Inc., Hauppauge, N.Y.) and splint, and covering the skin graft donor site with calcium alginate (Kaltostat; Calgon Vestal, St. Louis, Mo.), would allow successful outpatient skin grafting of burns to the upper extremity. Twelve patients with burns underwent debridement and split-thickness skin grafting on a total of 16 upper extremities with this method. Only patients who were otherwise healthy, had adequate home environments, and had burns limited to distal to the elbow were included for this initial trial. All skin graft donor sites were obtained from either the upper thigh or buttocks. Patients were discharged to home after 4 to 6 hours of observation and given amoxicillin for 5 days after surgery. Patients returned to the burn unit on the fifth postgrafting day for removal of the Unna's boot dressing, initiation of occupational therapy to the hands, and reapplication of a new calcium alginate dressing if needed. This and subsequent follow-up visits revealed a 95% or more take on all skin grafts, without any infectious complications. These results demonstrate the efficacy of Unna's boot support and calcium alginate dressings of donor sites in limited skin graft procedures. Furthermore, these results suggest that more extensive surgical debridements and skin graftings may be successfully shifted to outpatient procedures with use of these adjuvants.

Adolescent↗
PubMed2007

The potential utility of fibrin sealant dressing in repair of vascular injury in swine.

BACKGROUND: A previous study in which fibrin sealant dressing (FSD) secured hemostasis in major arterial hemorrhage for 96 hours suggested the applicability of this dressing in damage control operations after severe trauma. The objective of this study was to determine the effective duration of FSD hemostatic function in vivo and to examine its potential utility for definitive repair of a major arterial injury in swine. METHODS: High pressure bleeding in an infrarenal aortotomy was controlled by placing FSD on the wound with 4-minute compression (n = 15). If hemostasis was achieved, the abdominal cavity was closed. Surviving animals were killed at 2, 4, 6, and 8 weeks and aortotomy sites collected for histology. RESULTS: FSD stopped arterial hemorrhage after 4-minute compression in 14 of 15 (93%) pigs. Dressings failed in two pigs at 36 and 53 minutes after treatment. Twelve (80%) animals recovered and resumed normal activities. Of the remaining 12, two developed rebleeding at the aortotomy site on days 8 and 11 and were killed; another was killed because of idiopathic low hematocrit on day 10. Nine pigs survived until scheduled to be killed, maintaining hemostasis with stable hematological values. In the surviving animals, serial computed tomography scans showed formation of a pseudoaneurysm at the aortotomy site, which resolved after 2 to 3 weeks. The initial vascular defect and pseudoaneurysm were filled with fibroblast-myoblast collagen rich tissues covered by endothelium. CONCLUSION: FSD can seal an arterial injury, stop high pressure bleeding, and prevent rebleeding for at least 7 days. The dressing may be most beneficial in damage control operations. If combined with an elective interventional radiologic procedure (e.g. embolization or stenting), it may also offer an alternative to suture repair of vascular injuries in cases where profuse bleeding obstructs visualization.

Analysis of Variance↗
PubMed1990

Accelerated epithelization under a highly vapor-permeable wound dressing is associated with increased precipitation of fibrin(ogen) and fibronectin.

In a previous study we showed that the use of a newly developed, highly water vapor permeable, PEU wound dressing accelerates the epithelization of partial-thickness wounds more than an occlusive wound dressing (OpSite) in comparison with air exposure. The purpose of this study was to investigate the distribution of fibrin(ogen), fibronectin, and type IV collagen during the epithelization process under these three conditions. The breathable PEU film enabled coagulation of the wound exudate, preserving it into a semisolid gelatinous state. This coagulum layer contained an abundant amount of fibrin(ogen) and fibronectin. In wounds occluded with OpSite film, depositions of fibrin(ogen) and fibronectin were less extensive. Migrating keratinocytes contained intracellular depositions of fibrin(ogen), suggesting that these cells phagocytize components of the provisional fibrin matrix during wound healing. It was concluded that accelerated epithelization underneath the highly water vapor permeable polyetherurethane film dressing is associated with the presence of a gelatinous coagulum containing fibrin(ogen) and fibronectin. We speculate that the enhanced healing rate might be caused by an increased concentration of growth-promoting factors present in the residual exudate underneath the PEU dressing.

Animals↗
PubMed1988

Comparison of a hydrocolloid dressing and paraffin gauze in the treatment of venous ulcers.

In-patients with venous leg ulcers showed increased healing rates with a hydrocolloid dressing (Granuflex), as compared with a traditional paraffin gauze dressing (Jelonet), in a randomized sequential crossover trial, although the difference was not statistically significant. Bacteriological studies showed that the hydrocolloid dressing favoured growth of both aerobes and anaerobes in significantly greater numbers compared with paraffin gauze. Heavy bacterial colonization had no effect on the healing rates of the ulcers. Granuflex is said to produce an anaerobic environment--survival of Pseudomonas aeruginosa, a strict aerobe, under Granuflex dressings, makes this seem unlikely.

Aged↗
PubMed1990

Ranking of the antipsoriatic effect of various topical corticosteroids applied under a hydrocolloid dressing--skin-thickness, blood-flow and colour measurements compared to clinical assessments.

In 10 patients with chronic plaque type psoriasis one or two plaques affected equally with psoriasis were chosen for study. Five punched out rings of a hydrocolloid dressing were applied to the psoriasis plaque(s). In each circular test area 20 mg of one of the following creams was applied: base, 1% hydrocortisone (DAK), 0.1% triamcinolone acetonide (Kenalogue), 0.1% betamethasone-17-valerate cream (Betnovate), and 0.05% clobetasol proprionate cream (Dermovate). The areas were occluded with a thin film of transparent hydrocolloid dressing (Comfeel Transparent Dressing), for 1 week. Non-invasive measurements (ultrasound skin thickness, laser-Doppler flowmetry, colorimetry) were performed before and after treatment. Therapeutic response was evaluated blindly by clinical score. The measurements showed a decline in blood flow, a decrease in skin thickness, and normalization of colour approaching that of normal skin, the more potent the corticosteroid used. The clinical scores showed the same: the more potent a corticosteroid used, the closer to the score of normal skin. Data on variability and applications of the methods are presented. The study concludes that potent corticosteroids occluded with a hydrocolloid dressing can clear psoriasis in 1 week. Short-course corticosteroid therapy appears harmless and relevant for clinical dermatology.

Administration, Topical↗
PubMed1983

A new primary wound dressing made of polyethylene oxide gel.

Vigilon is a new primary wound dressing consisting of 96% water and polyethylene oxide. This moisture-containing, occlusive dressing absorbs its own weight in wound exudate and allows free transfer of oxygen. It is non-adherent and appears to promote better wound healing than that reported by other occlusive dressings, making it an ideal dressing for a wide variety of dermatologic surgery.

Dermabrasion↗
PubMed2004

Moist exposed therapy: an effective and valid alternative to occlusive dressings for postlaser resurfacing wound care.

BACKGROUND: Laser resurfacing has now become an accepted and important component of facial rejuvenation. With the introduction of computerized scanning systems, the actual laser resurfacing technique has been greatly simplified; however, the final outcome still depends to a large extent on the efficiency of the postlaser wound care in promoting wound healing and preventing early and late complications. It has been repeatedly confirmed that a moist environment is the single most important external factor affecting the rate of re-epithelialization. Occlusive moisture-retentive dressings, however, are difficult to apply and maintain in position and may as well be complicated by serious infections. OBJECTIVE: Moist exposed burn ointment has been shown to maintain adequate moisture for optimal healing by frequent ointment application without the need for a secondary overlying dressing. It would be ideal for postoperative laser care. METHODS: Twenty-eight consecutive patients treated with coherent ultrapulse CO2 laser in Toulouse, France, were included in the trial. Moisture-retentive ointment was applied over the treated areas every 4 to 6 hours. Healing was assessed clinically and with repeated transepidermal water loss measurements. Swab cultures were taken, and pain was evaluated with a visual analog scale. Colorimetric analysis of pictures taken was statistically compared with picture analysis of 20 patients treated earlier with an occlusive dressing. RESULTS: Uneventful timely healing occurred in all patients with minimal pain and discomfort. Healing with moist exposed therapy resulted in faster recovery of cutaneous erythema, as evidenced by colorometry. CONCLUSION: Moist exposed burn ointment application can be safely considered a good and valid alternative to occlusive dressings for postoperative laser care.

Colorimetry↗
PubMedDate not supplied

Management of intractable sternal wound infections with topical negative pressure dressing.

BACKGROUND: Sternal osteomyelitis after cardiac surgery is a life-threatening complication. The potential spread of infection into the mediastinum, involving the prosthetic valve, grafts, and suture lines, makes this an extremely serious complication confronting both cardiac and plastic surgeons. AIM: Topical negative pressure (TNP) dressing has been proven to be effective for wound healing. We want to take advantages of this equipment to improve the results of intractable sternal wound infection. The results are discussed. METHODS: From December 1996 to July 2002, 25 patients with sternal wound infections were treated at Kaohsiung Medical University Hospital. Nine patients suffering intractable sternal osteomyelitis were managed with debridement and TNP dressings. These patients received 1-3 debridements (an average of 2.2 debridements), and the average TNP dressing treatment period was 20.2 days (ranging from 3 to 43 days). After management, the infections were controlled and healthy vascularized wounds were achieved. Then, flap reconstruction could be performed for complete wound closure. Seven of the nine patients survived, and there was no recurrence of sternal osteomyelitis during follow-up period (ranging from 5 to 70 months). CONCLUSION: The advantages of applying TNP dressings in cases of intractable sternal wound infections include (1) protecting the underlying mediasternal structure from infection, (2) permitting delayed sternal closure to avoid cardiac compression induced compromised cardiopulmonary function, (3) possibility of repeated wound inspection and bedside debridement, (4) cost-effectiveness of wound care, and (5) providing an option to promote sternal wound secondary healing for patients in poor physical condition.

Aged↗
PubMed2006

The management of wounds following primary lower limb arthroplasty: a prospective, randomised study comparing hydrofibre and central pad dressings.

Wound care following lower limb arthroplasty has not been subject to in-depth clinical research, primarily because such wounds usually heal without complication. However, when prosthetic implants are used, serious wound problems can be disastrous (Whitehouse et al. Infect Control Hosp Epidemiol 2002;23:183-9; Lindwell OM. Clin Orthop Relat Res 1986;211:91-103). We report the results of a prospective, randomised, controlled trial comparing a hydrofibre (Aquacel) and central pad (Mepore) dressing in the management of acute wounds following primary total hip or knee arthroplasty left to heal by primary intention. Dressing performance was measured in 61 patients receiving total hip or knee replacements. There was a significant reduction in the requirement for dressing changes before five postoperative days in the hydrofibre group (43% compared with 77% in the central pad group), and there were fewer blisters amongst patients in the hydrofibre group (13% compared with 26% in the central pad group). We conclude that there is a potential role for hydrofibre dressing in the management of arthroplasty wounds.

Adult↗
PubMed2006

Inflammatory inert poly(ethylene glycol)--protein wound dressing improves healing responses in partial- and full-thickness wounds.

In this study, a novel soft hydrogel system based on the poly(ethylene glycol)-protein conjugates was evaluated as an occlusive wound dressing material. The hydrogel material, referred by the name of BioAquacare, contains up to 96% of the liquid and is formulated with phosphate-buffered saline and safe preservative to control bacterial load in the open wounds. Performance of the BioAquacare as a wound dressing material was assessed in partial- and full-thickness wounds in pigs. Wound analysis comprised macroscopic determination of the wound size, histological examination of the healing tissues and biochemical characterisation of wound exudates. The wounds treated with BioAquacare healed without any signs of inflammation, skin irritation, oedema or erythema. Cellular composition of the reepithelialised wounds was very similar to that of the normal skin, with a well-developed stratum corneum and epithelial layer. It was observed that BioAquacare plays the role of a liquid compartment, which provides pronounced hydration effect and helps maintain a natural moist environment of the healing tissues. BioAquacare showed relatively low protein-absorbing activity, absorbing predominantly low-molecular-weight molecules, including interleukin (IL)-1beta, IL-6, transforming growth factor-beta1 and products of haemoglobin degradation. It is concluded that application of the moist BioAquacare dressing promotes fast reepithelialisation by creating favourable environment for keratinocytes proliferation and it also reduces scarring. The results show that BioAquacare can be considered as a safe, biocompatible and inflammatory inert wound dressing material.

Animals↗